Masculinities, Health And Chronic Illness: A Multi-Level Social Psychological Study In Two Urban Poor Communities In Accra, Ghana

ABSTRACT

Background: Hypertension, a major risk factor for cardiovascular diseases, is increasingly becoming prevalent among adult men in Sub-Saharan Africa. Despite the gendered burden and risk of hypertension among men, there is a lack of gendered analysis on chronic illness experiences of men in Ghana.

Objectives: This thesis examined masculinity, health and experiences of hypertension among men in two urban poor communities in Accra, Ghana’s capital. The gaps in the literature informed the multi-level social psychological framework which incorporated four main theories and concepts: masculinity theory, relational theory of men’s health, explanatory models of illness and biographical disruption.

Methodology: This study adopted the parallel mixed method design in collecting and analyzing both quantitative and qualitative data. The qualitative studies had a total of 93 participants; made up of 11 Focus Groups (FGD) with 78 participants and 15 hypertensive men. FGDs were used to explore constructions of masculinities, health and health behaviours among men and women. Semi-structured interviews were used to explore experiences of hypertension among men. Thematic analysis was used to analyze the data. The quantitative study used the third Wave of the ‘Urban Poverty and Health Survey’ to examine prevalence, awareness, treatment and control of hypertension among 551 respondents. Cross tabulations and Chi-Square tests were used. The second section of the quantitative study examined environmental risk of hypertension among men through spatial mapping and analysis of men’s social spaces, alcohol spaces and food spaces in Ga Mashie. Near neighbor analysis and Euclidean distance were used to analyze the spatial data.

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Results: In the two urban poor communities, constructions of masculinities are in hegemonic, subordinate, marginalized and complicit forms. Men are expected to conform to hegemonic notions of masculinity as providers; demonstrate sexual prowess, phallic competence, physical strength and exercise authority over women and children. However, threats to these hegemonic masculinities marginalize and subordinate men who consequently engaged in alcohol consumption and leisure activities to compensate for their masculine inadequacies. Constructions of masculinities are complex and contradictory in Ga Mashie, where subordinated gay men contested their identities and women assume the hegemonic masculine role as providers. Men’s health definitions although multidimensional and comprehensive were aligned with their hegemonic masculine notions of strength, sexual prowess and money.

At the community level, hypertension prevalence in the general population was 23.6%. Hypertension was more prevalent in women (26.5%) than men (20.1%) when compared to previous studies in the community. However, men’s level of awareness, treatment and control were lower compared to women.

The spatial analysis showed gendered social and recreational spaces for leisure and physical activities. These spaces provided psychosocial support for marginalized men and the context through the culture of drinking alcohol takes place. The clustered distribution of alcohol, unhealthy food spaces and a mix of healthy and unhealthy foods contribute to men’s consumption of alcohol and unhealthy diets which increase their risk of hypertension.

Participants’ explanatory models of hypertension and causal theories were eclectic but not comprehensive when compared to established biomedical theories. Hypertension caused psychosexual, financial, social disruption and psycho-emotional disruptions among men which shaped their illness actions. Emotions were central in men’s experiences of hypertension. Fear of

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sexual dysfunction was crucial in leading to non-adherence due to conformity to hegemonic masculinity. Spiritual, financial and psychological support helped men cope with hypertension.

Conclusion: The multi-level approach used in this study has shown that men’s health in poor communities are complex. The findings indicate that men’s health definitions and behaviours (interpersonal level) and hypertension experiences (intrapersonal level) are shaped by their hegemonic masculine ideologies (structural level) and community factors such as their social spaces, drinking spots and food spaces at the community or group level. These factors affect men’s hypertension treatment and control which has implications on their health and illness practices. This thesis contributes to the limited research on men’s health and non-communicable diseases in Ghana. It provides an in-depth and gendered analysis of men’s experiences with hypertension through a multi-level social psychological framework. Interventions must follow a multi-level approach and build the capacity of health workers to understand masculinities and men’s complex health needs.